Maternal and perinatal mortality are important health problems in the United States. Emerging causes of maternal deaths are embolism, cardiomyopathy, anesthesia complications, adult respiratory distress syndrome, and acquired immunodeficiency syndrome. Maternal deaths continue to be underreported. Active surveillance is needed to better identify maternal deaths and to understand their causes and risk factors. Although perinatal deaths have declined recently--primarily because technologic advances have improved low-birth-weight babies' chances for survival--they remain a problem, particularly among blacks. Clinicians should strive to reduce preventable deaths among black normal-birth-weight babies and to prevent low birth weight and premature birth among black infants. Future research should focus on determining whether early prenatal care and cesarean delivery actually reduce perinatal mortality. A better understanding of prenatal and intrapartum care and their benefits will help in the development of strategies to reduce perinatal and maternal deaths.